Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Abstract

Abstract:Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct <32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.